Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

Shin, Sung‐Hee; Hung, Chung‐Lieh; Uno, Hajime; Hassanein, Amira; Verma, Anil; Bourgoun, Mikhail; Køber, Lars; Ghali, Jalal K.; Velázquez, Eric J.; Califf, Robert M.; Pfeffer, Marc A.; Solomon, Scott D.

doi:10.1161/circulationaha.109.863795

Cited by 103 publications

(78 citation statements)

References 44 publications

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“…Advanced MRI techniques and speckle-tracking strain-related imaging (with 3-dimensional reconstruction) with ultrasound echocardiography have been shown to improve early predictions of outcomes in humans. 212 These new approaches may more accurately measure ventricular volumes and diastolic function in both small-and large-animal models. 213 If MRI is not available, then 3-dimensional transdiaphragmatic echocardiography or 2-dimensional transdiaphragmatic echocardiography should be considered (to alleviate problems with finding useable echocardiography windows).…”

Section: Noninvasive Imaging Modalitiesmentioning

confidence: 99%

Animal Models of Heart Failure

Houser¹,

Margulies²,

Murphy³

et al. 2012

Circulation Research

387

223

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Section: Noninvasive Imaging Modalitiesmentioning

confidence: 99%

Animal Models of Heart Failure

Houser¹,

Margulies²,

Murphy³

et al. 2012

Circulation Research

387

223

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“…39 The ability of strain imaging to quantify the regional timing of deformation has led to its widespread application in the assessment of ventricular synchrony. Quantifying the temporal dispersion in contractility has provided important insights into the load dependency of ventricular dyssynchrony, 40 the linkage between dyssynchrony and impaired contractile function, 41 and the prognostic relevance of dyssynchrony in select groups of patients with QRS duration Ͻ120 ms. 42 These measures have also been used to assess the relationship between dyssynchrony measures and response after resynchronization therapy. Using both the magnitude and timing of regional deformation, Delgado et al 43 demonstrated the importance of both lead positioning and contractile function, as they relate to the most delayed myocardial segment, in predicting response to cardiac resynchronization therapy.…”

Section: Quantification Of Regional Functionmentioning

confidence: 99%

“…One approach is to focus on those parameters more closely associated with clinical outcomes, and in this respect longitudinal deformation currently appears most promising. 42,46,48,50 In addition, few data are available regarding the feasibility and reproducibility of these measures when applied broadly, particularly for the regional measures. Moreover, data are lacking from large community-based cohorts to define normal ranges for these measures and to describe the manner in which they may vary by age and gender and to establish the relationship between these measures and clinical outcomes.…”

Section: Next Steps In the Application Of Deformation Imagingmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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M yocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function. As this technology has evolved, it has been applied to an increasing number of research questions, and the number of publications incorporating deformation imaging has grown in parallel.Although not yet sufficiently vetted for routine clinical use, these methods offer the long-term potential for more complete, accurate, and reproducible assessment of myocardial function. What Is Myocardial Deformation Imaging?Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function.During systole, the ventricular myocardium simultaneously shortens in the longitudinal and circumferential planes and thickens in the radial plane, with reciprocal changes in diastole ( Figure). Deformation imaging, in the broadest sense, allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate. Strain is defined as the change in length of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the rate of this deformation. Longitudinal and circumferential shortening results in negative strain values, whereas radial thickening results in a positive strain value. Previously, assessment of myocardial strain could be performed with the use of sonomicrometry crystals, which can only be performed experimentally 1 or with magnetic resonance imaging-based myocardial tagging, 2,3 which is limited by relatively low temporal resolution and the limited availability and expense of cardiac magnetic resonance imaging. Extension of these techniques to echocardiography has allowed for substantially greater utility in a broader range of patients.Myocardial deformation imaging with echocardiography can be performed with the use of either tissue Doppler-based or 2-dimensional speckle tracking-based methods. Doppler methods, developed initially, utilize the velocity gradient present along the length of the left ventricle (LV) to calculate strain rate, which is then integrated to derive strain. This technique suffers from limitations similar to those of traditional Doppler because it can only accurately assess deformation in the plane incident with the ultrasound beam and requires prospective acquisition of dedicated images at high frame rate. B-mode speckle tracking, sometimes referred to as feature tracking, utilizes the movement of the coherent ultrasound backscatter speckle pattern within B-mode echocardiographic images to assess myocardial...

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“…8 -10 The pronounced mechanical dispersion found in our LQTS patients was related to ventricular arrhythmias and is likely to reflect electric dispersion. Heterogeneous ventricular contraction can also be caused by fibrosis in myocardial tissue and has been related to ventricular arrhythmias 22 and death 23 in patients after myocardial infarction.…”

Section: Electric Dysfunction and Mechanical Consequences In Lqtsmentioning

confidence: 99%

Transmural Differences in Myocardial Contraction in Long-QT Syndrome

et al. 2010

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Background-Long-QT syndrome (LQTS) is characterized by prolonged myocardial action potential duration. The longest action potential duration is reported in the endomyocardium and midmyocardium. Prolonged action potential duration in LQTS may cause prolonged cardiac contraction, which can be assessed by strain echocardiography. We hypothesized that myocardial contraction is most prolonged in subendocardial myofibers in LQTS patients and that inhomogeneous transmural contraction is related to the risk of spontaneous arrhythmia. Methods and Results-We included 101 genotyped LQTS mutation carriers and 35 healthy individuals. A history of cardiac arrhythmias was present in 48 mutations carriers, and 53 were asymptomatic. Myocardial contraction duration was assessed by strain echocardiography as time from the ECG Q wave to peak strain in 16 LV segments. Strain was assessed along the longitudinal axis, predominantly representing subendocardial fibers, and along the circumferential axis, representing midmyocardial fibers. Mean contraction duration was longer in LQTS mutation carriers compared with healthy individuals (445Ϯ45 versus 390Ϯ40 milliseconds; PϽ0.001) and longer in symptomatic compared with asymptomatic LQTS mutation carriers (460Ϯ40 versus 425Ϯ45 milliseconds; PϽ0.001). Contraction duration by longitudinal strain was longer than by circumferential strain in symptomatic LQTS patients (460Ϯ45 versus 445Ϯ45 milliseconds; Pϭ0.008) but not in asymptomatic patients and healthy individuals, indicating transmural mechanical dispersion. This time difference was present in a majority of LV segments and was most evident in patients with LQT2 and the Jervell and Lange-Nielsen syndrome. Conclusion-Contraction duration in symptomatic LQTS mutation carriers was longer in the subendocardium than in the midmyocardium, indicating transmural mechanical dispersion, which was not present in asymptomatic and healthy individuals. (Circulation. 2010;122:1355-1363.)

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Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

Cited by 103 publications

References 44 publications

Animal Models of Heart Failure

Animal Models of Heart Failure

Myocardial Deformation Imaging

Transmural Differences in Myocardial Contraction in Long-QT Syndrome

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